Voting

Is there a way to decrease the risks for HLB disease leveraging the H3Africa genomics platform?
• Leverage partnerships providing resources to the H3African populations
• Identify the best collaborative partners to reach out to the low resource population
• Find the best mechanism for collaborations to facilitate the interventions in low resource settings
• Merge NHLBI research objectives and goals with those of potential
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• Leverage the existing infrastructure (NHLBI & UnitedHealth investment in the Centers of Excellence in Kenya and South Africa; NIH and Wellcome Trust investment in H3Africa) to decrease the burden of HLB using genomics in low resource settings

• Proof of concept: H3African countries & affiliated sites can be used to create a T4 model

• Extension: expand the H3Africa model to other LMICs

Feasibility and challenges of addressing this CQ or CC:

• Existing NHLBI investment in capacity building in some of the H3African countries can be leveraged to address heart, lung, blood, sleep diseases

Name of idea submitter and other team members who worked on this idea:
NHLBI Staff

• Would help identify key factor associated with successful implementation that could be studied in interventional T4 implementation research

• Result would refine implementation strategies and health and social policy aimed to reduce heart, lung, blood, sleep diseases and conditions

• Builds on excellent established platform of research with high quality outcomes in well characterized study populations over long term follow-up.

Feasibility and challenges of addressing this CQ or CC:

• Big data is developing methods to link large data sets from national, state, and community level surveys – surveys that can define exposures to various policies and interventions in place, time, and population.

• A family of high quality cohorts are available for ancillary observation studies

• Collection of community level and more broad policy level exposures is feasible through data already collected and through potentially new data collection.

Name of idea submitter and other team members who worked on this idea:
NHLBI Staff

Voting

We need much more support for critical basic research to understand and develop transformative therapies for this enormous health care burden. This is not simply a question of epidemiology and large multicenter population data bases. We really need hard core science. It is impossible to know where the next breakthrough will come, and setting aside funds for hot button things - stem cells, or iPS, or gene editing per
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NIH needs to stop trying to guess what the next big thing is and putting funds aside to support something that is popular at the moment. This has been done frankly with GWAS, with Stem cells, and perhaps ongoing now with "personalized medicine". All hot areas, but so are a ton of other things. IN my 30 years as a physician scientist, I cannot count on one hand the number of discoveries that were really transformative that came out of this type of ear-marked planning. Need more resources to support innovative individual scientists, particularly those with a track record of discovery, translation, and iinnovation We do not do that well enough at all.

- Affordable Care Act (ACA) includes both general and explicit provisions that could narrow the health disparities gaps through implementation research.

- Can leverage and build upon current research partnerships that exist between government agencies and health care delivery systems to address questions of major public health importance

- Opportune time to employ implementation research addressing health inequities through non-traditional research partnership with sectors such as education, state and local government, transportation (built environment), penal and re-entry systems (health risks and disparities), ministries of health, and for-profits, foundations, and non-profits with health care focus.

Challenges:

- Risk of disagreements and friction among partners and management with different priorities

- Synchronization of timing for decision making

- Achieving partners’ concurrence on decisions that provide the most cost effective solutions

- Time needed to establish trust among partners that do not routinely partner to address health inequities

- There are limited resources dedicated to fostering Public Private Partnerships

Name of idea submitter and other team members who worked on this idea:
NHLBI Staff

T-32 programs train few thousands junior biomedical scientists every year. Training grants that succeed in integrating multiple discipline will produce a workforce that is more attuned to the needs of modern medicine and will be more competitive in the job market of the 21st century.

Feasibility and challenges of addressing this CQ or CC:

Activities along this line can be implemented immediately by strongly encouraging the institutions to revise or re-design their training programs.

Interdisciplinary training has become a necessity in the present time; there is a strong interest in today’s medicine at looking at the patient in its entirety and at disease processes from all angles. This requires data integration and scientists that are familiar with the language of different disciplines and can ask scientific and medical questions that span these disciplines.

Name of idea submitter and other team members who worked on this idea:
NHLBI Staff

Reduce the almost epidemic increase in the occurrence of AF in the aging U.S. population. This is a critical need for which basic science and clinical tools presently exist to address and resolve into a means to reduce the clinical consequences of AF.

Feasibility and challenges of addressing this CQ or CC:

To accomplish this goal the following approaches could be taken:

GENETIC: Investigate genetic factors that drive susceptibility to atrial fibrillation in various disease states and “lone” AF.

BASIC: Investigate the principles underlying electrical and structural remodeling which facilitate and perpetuate atrial fibrillation. Use a systems approach to aid the understanding of the role of neurohormonal and other organ system influences on human cardiac electromechanical activity. Develop new imaging modalities to better characterize conduction abnormalities in three dimensions. Investigate the nature of chamber-specific channels as potential targets for AF therapies. Encourage the development of new thrombin inhibitors and other potent but safe anticoagulants.

TRANSLATIONAL: Investigate promising pharmacologic or other interventions designed to reduce the incidence of atrial fibrillation in animal models with spontaneously occurring atrial fibrillation. Create the infrastructure for a “dynamic repository” of clinically obtained fresh human cardiac tissue for the study of AF.

CLINICAL: Improve the collection of atrial fibrillation as an endpoint in large phenotyped cohorts. Evaluate the safety and efficacy of ablative procedures relative to appropriate pharmacologic therapies. Evaluate interventions which may prevent first development and recurrence of AF (statins, ACE-I/ARB, beta blockers). Investigate the use of new antiplatelet thienopyridines for stroke prevention in AF.

Name of idea submitter and other team members who worked on this idea:
NHLBI Staff

Improving the ability of scientists to communicate the importance of their research will make science attractive to younger generations, increase collaborations and funding opportunities, and may increase general public support for research and researchers.

Feasibility and challenges of addressing this CQ or CC:

Tested models already exist in other countries. The public seems to be increasingly interested in reading press releases about discoveries in different areas, which now are regularly published in popular press (e.g., NYT)

Researchers rarely receive formal training for teaching, public speaking, and many lack even basic communication training. Learning how to better communicate science can help increase the attractiveness and impact of science by engaging colleagues, collaborators, attracting interest from potential future scientists, subjects for clinical studies, funding agencies, and the public in general. Being able to explain the research goals, scientific approach, and discoveries in clear and simple terms, makes science sound "cool" and can attract wide interest (for instance, think "CSI"). In other countries, science communication is part of the science graduate curriculum and their funding agencies require having a communication plan for the wide dissemination of findings of the research proposed (which is part of the application score!).

Name of idea submitter and other team members who worked on this idea:
NHLBI Staff

Could lead to the development of fundamental knowledge required to develop effective new therapeutic interventions to treat heart disease.

Feasibility and challenges of addressing this CQ or CC:

Several studies have already demonstrated associations been NANC transmitter release and neuropeptide co-localization with pathogenic changes in cardiac function.

Identification within cardiac nerves of neural peptides that are co-released with traditional transmitters is an interesting and still emerging story. Studies with nonadrenergic, noncholinergic (NANC) transmitters in both the atria and ventricle have shown that a variety of neuropeptides also are localized within the heart, and several, including vasoactive intestinal peptide (VIP), neuropeptide Y (NPY), substance P, and calcitonin gene-related peptide, have been shown to markedly affect heart rate and modulate cardiac function. NPY is also elevated in heart failure patients, and other neuropeptides, including VIP, calcitonin gene related peptide (CGRP), substance P (SP) and their receptors are associated with various types of cardiomyopathies.

Name of idea submitter and other team members who worked on this idea:
NHLBI Staff

Low tidal volume ventilation has been shown to significantly reduce mortality in ARDS patients (from 40% to 31% in the ARMA trial published in NEJM in 2000), but it is inconsistently adopted (frequently with rates <50% in both community and academic settings). Improving adherence has the potential to significantly improve mortality in patients with ARDS.

Feasibility and challenges of addressing this CQ or CC:

Given the rapid growth and interest in the field of implementation science over the past several years, addressing this question is now feasible.

To extend our knowledge of the pathobiology of heart, lung, blood, and sleep disorders and enable clinical investigations that advance the prediction, prevention, preemption, treatment, and cures of human disease.